Pedro Ribeiro Barbosa

Caracterização gerencial dos hospitais filantrópicos no Brasil

This paper presents the management characteristics of charity hospitals in Brazil, based on data from a national survey developed in 2001. The sample accounted for the random inclusion of 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds and all 26 hospitals with at least 599 beds. It also included 10 institutions assumed as non-providers of services to the SUS. The analyses are descriptive, focusing on the classification of the hospitals according to their managerial development level, as well as selected issues regarding the utilization of specific managerial technologies, human resources, technical services, and services contracting. Distinct managerial levels were identified, but it is important to note that 83% of the SUS providers with less than 599 beds were classified as having incipient management. The authors discuss implications of the findings for inpatient care policies, considering the importance of charity hospitals for the Brazilian Health System.

A dinâmica do sistema produtivo da saúde: inovação e complexo econômico-industrial

Esta publicacao integra o projeto Perspectivas de Investimento no Brasil, desenvolvido em 2008 e 2009 pelos institutos de Economia da Universidade Federal do Rio de Janeiro (UFRJ) e da Universidade Estadual de Campinas (Unicamp) em parceria com o Banco Nacional de Desenvolvimento Economico e Social (BNDES). Para o desenvolvimento da analise referente ao Complexo Economico-Industrial da Saude (CEIS), os coordenadores do projeto se associaram a pesquisadores do Grupo de Inovacao em Saude da Escola Nacional de Saude Publica Sergio Arouca da Fundacao Oswaldo Cruz (GIS/Ensp/Fiocruz), coordenado por Carlos Gadelha. O resultado dessa iniciativa pode ser visto neste livro, que apresenta uma versao revista e atualizada de relatorio do GIS/Ensp/Fiocruz, no âmbito do referido projeto; Bibliografia: p. 209-221; Documento online disponivel em: http://books.scielo.org/id/6t3hs/pdf/gadelha-9788575415931.pdf; Todo o conteudo deste trabalho, exceto quando houver ressalva, e publicado sob a licenca Creative Commons Atribuicao 4.0, que da o direito de: Compartilhar — copiar e redistribuir o material em qualquer suporte ou formato; Adaptar — remixar, transformar, e criar a partir do material para qualquer fim, mesmo que comercial. Esta licenca e aceitavel para Trabalhos Culturais Livres. O licenciante nao pode revogar estes direitos desde que se respeite os termos da licenca.De acordo com os termos seguintes: Atribuicao — Deve-se dar o credito apropriado, prover um link para a licenca e indicar se mudancas foram feitas. Voce deve faze-lo em qualquer circunstância razoavel, mas de nenhuma maneira que sugira que o licenciante apoia voce ou o seu uso. Sem restricoes adicionais — Voce nao pode aplicar termos juridicos ou medidas de carater tecnologico que restrinjam legalmente outros de fazerem algo que a licenca permita.

Estudo de satisfação dos beneficiários de planos de saúde de hospitais filantrópicos

This paper presents the findings of research aimed at identifying and analyzing the argumentation and rationale that justify the satisfaction of consumers with their health plans. The qualitative method applied used the focus group technique, for which the following aspects were defined: the criteria for choosing the health plans which were considered, the composition of the group and its distribution, recruitment strategy, and infrastructure and dynamics of the meetings. The health plan beneficiaries were classified into groups according to their social class, the place where they lived, mainly, the relationship that they established with the health plan operators which enabled us to develop a typology for the plan beneficiaries. Initially, we indicated how the health plan beneficiaries assess and use the Brazilian Unified Health System (SUS), and, then, considering the types of plans defined, we evaluated their degree of satisfaction with the different aspects of health care, and identified which aspects mostly contributed explain their satisfaction.

Caracterização assistencial de hospitais filantrópicos no Brasil

OBJECTIVE To characterize the Brazilian philanthropic hospital network and its relation to the public and private sectors of the Sistema Unico de Saude (SUS) [Brazilian Unified Health System]. METHODS This is a descriptive study that took into consideration the geographic distribution, number of beds, available biomedical equipment, health care complexity as well as the productive and consumer profiles of philanthropic hospitals. It is based on a sample of 175 hospitals, within a universe of 1,917, involving 102 distinct institutions. Among these, there were 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds randomly included in this study. Twenty-six of the twenty-seven SUS inpatient care providers with at least 599 beds, as well as ten institutions which do not provide their services to SUS, were also included. This is a cross-sectional study and the data was obtained in 2001. Data collection was conducted by trained researchers, who applied a questionnaire in interviews with the hospitals managers. RESULTS Within the random sample, 81.2% of the hospitals are located in cities outside of metropolitan areas, and 53.6% of these are the only hospitals within their municipalities. Basic clinical hospitals, without ICUs, predominate within the random sample (44.9%). Among the individual hospitals of the large philanthropic institutions and the special hospitals, the majority -- 53% and 60% respectively -- are level II general hospitals, a category of greater complexity. It was verified that complexity of care was associated to hospital size, being that hospitals with the greatest complexity are situated predominantly in the capitals. CONCLUSIONS Given the importance of the philanthropic hospital sector within the SUS [Unified Health System] in Brazil, this paper identifies some ways of formulating appropriate health policies adjusted to the specificities of its different segments.

Hospitais filantrópicos e a operação de planos de saúde próprios no Brasil

OBJECTIVE To describe the management performance of philanthropic hospitals that operate their own health plans, in comparison with philanthropic hospitals as a whole in Brazil. METHODS The managerial structures of philanthropic hospitals that operated their own health plans were compared with those seen in a representative group from the philanthropic hospital sector, in six dimensions: management and planning, economics and finance, human resources, technical services, logistics services and information technology. Data from a random sample of 69 hospitals within the philanthropic hospital sector and 94 philanthropic hospitals that operate their own health plans were evaluated. In both cases, only the hospitals with less than 599 beds were included. RESULTS The results identified for the hospitals that operate their own health plans were more positive in all the managerial dimensions compared. In particular, the economics and finance and information technology dimensions were highlighted, for which more than 50% of the hospitals that operated their own health plans presented almost all the conditions considered. CONCLUSIONS The philanthropic hospital sector is important in providing services to the Brazilian Health System (SUS). The challenges in maintaining and developing these hospitals impose the need to find alternatives. Stimulation of a public-private partnership in this segment, by means of operating provider-owned health plans or providing services to other health plans that work together with SUS, is a field that deserves more in-depth analysis.

O papel dos hospitais na dinâmica de inovação em saúde

O artigo analisa o papel dos servicos hospitalares na dinâmica de inovacao em saude, considerando-os como forca motriz do processo de inovacao no Complexo Economico-Industrial da Saude. Alem disso, enfatiza-se a potencialidade desses servicos em articular virtuosamente as dimensoes socioeconomicas do desenvolvimento. Utilizando-se do arcabouco da economia politica da saude, propoem-se aportes para o desenvolvimento de uma base analitica e de novos modelos de analise estrategica das condicoes institucionais, tecnologicas e de gestao hospitalar, bem como de suas inter-relacoes no complexo produtivo da saude. O artigo objetiva, dessa forma, aprofundar a compreensao sobre a dinâmica de inovacao a partir dessas organizacoes.

Parcerias na saúde: as Organizações Sociais como limites e possibilidades na gerência da Estratégia Saúde da Família

This is a case study in the municipality of Rio de Janeiro about management in the Family Health Strategy based on the Social Organizations model. The aims were to characterize and analyze aspects of the governance system adopted by the Rio de Janeiro Municipal Health Department and identify limits and possibilities of this model as a management option in Brazil’s Unified Health System. A qualitative study was performed based on a literature review, document analysisand interviews with key informants. This management model facilitated the expansion of access to primary healthcare through the Family Health Strategy in Rio – where the population covered increased from 7.2% of the population in 2008 to 45.5% in 2015. The results showthat some practices in the contractual logic need to be improved, including negotiation and accountability with autonomywith the service suppliers. Evaluation and control has focus on processes, not results, and there has not been an increase in transparency and social control. The system of performance incentives has been reported as inducing improvements in the work process of the health teams. It is concluded that the regulatory capacity of the municipal management would need to be improved. On the other hand, there is an important and significant process of learning in progress.This is a case study in the municipality of Rio de Janeiro about management in the Family Health Strategy based on the Social Organizations model. The aims were to characterize and analyze aspects of the governance system adopted by the Rio de Janeiro Municipal Health Department and identify limits and possibilities of this model as a management option in Brazils Unified Health System. A qualitative study was performed based on a literature review, document analysisand interviews with key informants. This management model facilitated the expansion of access to primary healthcare through the Family Health Strategy in Rio - where the population covered increased from 7.2% of the population in 2008 to 45.5% in 2015. The results showthat some practices in the contractual logic need to be improved, including negotiation and accountability with autonomywith the service suppliers. Evaluation and control has focus on processes, not results, and there has not been an increase in transparency and social control. The system of performance incentives has been reported as inducing improvements in the work process of the health teams. It is concluded that the regulatory capacity of the municipal management would need to be improved. On the other hand, there is an important and significant process of learning in progress.

El papel de los hospitales en la dinámica de innovación en salud

O artigo analisa o papel dos servicos hospitalares na dinâmica de inovacao em saude, considerando-os como forca motriz do processo de inovacao no Complexo Economico-Industrial da Saude. Alem disso, enfatiza-se a potencialidade desses servicos em articular virtuosamente as dimensoes socioeconomicas do desenvolvimento. Utilizando-se do arcabouco da economia politica da saude, propoem-se aportes para o desenvolvimento de uma base analitica e de novos modelos de analise estrategica das condicoes institucionais, tecnologicas e de gestao hospitalar, bem como de suas inter-relacoes no complexo produtivo da saude. O artigo objetiva, dessa forma, aprofundar a compreensao sobre a dinâmica de inovacao a partir dessas organizacoes.

The role of hospitals in the dynamic of health care innovation

O artigo analisa o papel dos servicos hospitalares na dinâmica de inovacao em saude, considerando-os como forca motriz do processo de inovacao no Complexo Economico-Industrial da Saude. Alem disso, enfatiza-se a potencialidade desses servicos em articular virtuosamente as dimensoes socioeconomicas do desenvolvimento. Utilizando-se do arcabouco da economia politica da saude, propoem-se aportes para o desenvolvimento de uma base analitica e de novos modelos de analise estrategica das condicoes institucionais, tecnologicas e de gestao hospitalar, bem como de suas inter-relacoes no complexo produtivo da saude. O artigo objetiva, dessa forma, aprofundar a compreensao sobre a dinâmica de inovacao a partir dessas organizacoes.